OzOne wrote
So please explain the process of supply and demand driving up prices.


Back when I was sleeping through economics classes a prof showed us an equation
for maximizing profits. Supply and demand were among the variables that had to
be estimated but the prof pointed out that in mature industries (like refining)
that these factors were well known and coul be accurately predicted. What was
amazing was how a minor (1 or 2%) change in the supply/demand ratio increased or
decreased prices and thus profits. Maybe some of the business majors here can
provide the actual equation and typical figures.

"Dave" wrote in message
...
Well spoke, Peter.

"Well spoke" ?

"Peter Wiley" wrote in message
. ..

Good. I don't know how much congruence there is between Australian
medicine and the USA, but having doctors who are primarily interested
in curing the sick and preventing sickness strikes me as much better
selection criteria than people who are interested in money & prestige.
I don't have any problem with them having all of the above, just the
order of importance.

In order from most common to least, the reasons given by pre-med students
during selection process interviews with US medical schools is: 1) a
desire to practice medicine, 2) a desire to help people, 3) a need to be
involved in something significant and important, 4) the money, and 5) the
prestige. But when first year medical students were interviewed, the order
was somewhat different, with money and prestige leading the list. So, are
we to believe your Ozzy medical students are any different than our own?
Have you actually talked to any med students there, or are you just shooting
from the patriotic hip?

Here, at least 1 med school screens candidates on a range of social
factors as well as straight exam performance. Can't see that the
results are noticeably worse.

They do precisely the same here. Often the straight-A students are passed
over in favor of those who perhaps had slightly worse GPAs (3.7 to 3.9 on a
4.0 scale) but were involved in extracurricular activities such as
charitable organizations, self-improvement projects, and athletics.
Well-rounded individuals, it seems, make better physicians than bookworms.
Imagine that.

With the exception of cutting edge research, it doesn't really take
that many brains to be a doctor, and the really bright ones get super
bored anyway if they can't do new interesting things all the time.

The really bright ones generally find themselves in academia or pure and
applied research. You are correct in that it doesn't take an Einstein to
practice family medicine.

Do I know anything of what I'm talking about? Maybe not, but my wife is
a PhD from UNSW Medical school (ie, not a MD) and a department head at
one of Australia's biggest teaching hospitals. I have, unfortunately,
had 30+ years of moderately close social association with doctors and
fellow medical researcher types. They were/are no brighter overall,
than my colleagues in other R&D fields, but God, most *think* they are.

Often the MD suffix is synonymous with runaway ego. Rational individuals
generally place those with PhDs above MDs in the cosmic brilliance pecking
order.


BTW, it's harder to get into vet school than medicine here in Oz.

Same here. Numerically medical schools take a higher percentage of their
qualified applicants than do veterinary schools.

Less
places. Exam score (TER - equiv to your SAT most likely) is as high or
higher for vet as medicine. It's just a rationing mechanism, not a
determinant of needed ability.

The primary reason for more applicants for fewer positions in vet schools is
that many people envision helping animals as nobler than helping humans.
Not sure why, but studies have shown that veterinary medicine is the most
desirable health care profession in the US. It's not for the money, albeit
vets have increased their fees and subsequently their incomes dramatically
over the past twenty years, relative to most other non-medical professions.

Max

"Martin Baxter" wrote in message
...
Maxprop wrote:

"Frank Boettcher" wrote in message
...

Today the average doctor makes
approximately five times and much and many specialists make 15-20
times.

Where have you been, Frank? 15-20x? Hardly. Nearly all medical
reimbursement to physicians is now third party, and the rates of
reimbursement have been cut dramatically.

That is *one* good thing you can say for Canada's system, only one
entity to bill. In my province you submit your claim to OHIP once a
month, 21 days later they direct deposit into your account. How many
insurance companies do you have to bill each month, do they all have the
same the claim forms, same claim procedure? I'll bet this doesn't do
much to lower your administrative overhead.

We are forced to bill numerous third party carriers here, each with
different forms (all on-line now, however) and different reimbursement
rates. But the primary difference is that we can pick and choose those
carriers we choose to accept, and reject those with reimbursement rates too
low to allow us to be profitable or those whose service is substandard. In
your situation, your physicians have no choice. They either accept what the
government is going to reimburse them for their services, or they can sell
shoes for a living.

One other point: we have extensive government third party claims here, too,
but not as extensive as yours. What is relevant, however, is that the way
the government processes claims is never the same way twice (NTSWT--a
popular acronym among the health care crowd). Inconsistency doesn't bother
the patient, but it makes life absolutely hell for practitioners.

Max

"Frank Boettcher" wrote in message
...
On Fri, 05 May 2006 04:46:02 GMT, "Maxprop"
wrote:


"Frank Boettcher" wrote in message
. ..

Today the average doctor makes
approximately five times and much and many specialists make 15-20
times.

Where have you been, Frank? 15-20x? Hardly. Nearly all medical
reimbursement to physicians is now third party, and the rates of
reimbursement have been cut dramatically. Whereas a cardiologist could
reasonably presume to earn in excess of $500K per year in the mid-90s,
today
they are lucky to clear $200K before taxes on average. Top-notch surgeons
used to earn well over a million per year, but work harder now, do more
surgeries and make half that or less. There are a few physicians in
private-pay only settings who still make the megabucks, but they are few
and
far between.

In an industry that controls supply side by the number of
available seats in Medical schools which is way out of proportion to
the talent available.

Really? Have you chatted with emerging med school grads these days? My
recommendation to you is that you'd be well-advised to stay very healthy
in
your later years. Entrusting your life to some of these new physicians
would seem riskier than skydiving. Medicine doesn't pay nearly as well as
it used to, ergo the top-notch students don't apply to the schools in the
percentage they used to. They now go into computer-related and finance
fields, where the money is. I was one of 69 optometry students chosen
from
a field of nearly 1000 qualified applicants in 1980. Today the entering
class at my school is 60 students drawn from roughly 450 qualified
applicants. Med schools take about 250 students annually from a field of
roughly 1500 applicants, but of the 1250 who don't get into one school,
about 70% of them get into another school. You've implied that the supply
side of medical doctors is controlled ostensibly to keep earning high for
those in the profession. What would you propose? Would you take all of
the
qualified applicants in order to spread the money around? And what would
the result of that move be? My best guess is that fewer and fewer
qualified
applicants would show up each year. Money and prestige are and always
have
been the primary driving force behind the interest in medicine, but are
becoming mitigated more and more each year. Stay healthy.

You're contradicting yourself Max. On the one hand you talk about
emerging class being substandard as an indication of the pool and
since I know a number of them (but not necessarily a relevant sample)
I can't concur; on the other you talk about 450 qualified applicants
with 60 selected.

Not contradictory at all. The point I didn't make is that the applicant
pools are dwindling somewhat, but they are also comprised of less-qualified
students than, say, 25 years ago. For example, anyone with a GPA of less
than 3.8 needn't have applied to med school in the Seventies. Today the
average "qualified" applicant has a GPA of roughly 3.4. And of course
programs that still utilize affirmative action use a dual standard for
qualifications, allowing GPAs as low as 2.8, plus or minus, for minorities.

And I don't believe a high percentage of those not
selected get in at another school.

Believe what you will--it's true. Of the 1900+ qualified applicants who
applied to Indiana University School of Medicine in 2001, only 250 were
accepted at IU. Of the remaining applicants fully 70% or more were accepted
elsewhere. Most applicants use the "buckshot" approach in applying to
medical school, sending out anywhere from 3 to 15 applications--a busy and
expensive process, but with generally good results.


Are you concluding that doctors if paid $200K per year will become
discouraged, quit the field and become something else, or will as a
result of that "low" pay give substandard service.

A few will when they consider the work, the responsibility, the hours, the
call, the legal ramifications, the hassles, the busywork, the politics, and
other factors, not the least of which is that many doctors entered the
profession believing they'd earn far more. More importantly, the top-notch
students won't apply to med school at all, knowing better money is available
elsewhere with less gruesome responsibilities and hours.

My position is
that fees will come down with more competition but the pay will remain
attractive to entry.

It IS attractive to some, but generally those people aren't the same quality
of individual that used to be attracted to medicine. I say "generally"
because some very good people do enter medicine, but the overall quality has
slipped, and organized medicine will be the first to admit it.


And that has been going on most of my life. As
a pre-65 forced retiree I spend five times as much for health care as
gasoline. And I'm healthy. And I don't hear very much about that.

Do you really believe physicians' fees are responsible for the high cost
of
medical care?

Yes, to the extent of their poroportional impact on the total cost of
health care. Their fees also include their overhead which includes
their liability insurance among other things.

If you are hospitalized for an MI (myocardial infarction = heart attack)
your total bill will typically break down this way: 75% hospital bill, 15%
physician's fees, 10% associated costs, such as outsourced MRIs, etc.
That's quite oversimplified, but relatively representative. Thanks to
managed care, physician reimbursements have been cut dramatically. The
single biggest increase in the cost of health care is hospitalization, with
the profit to third-party carriers a close second. In a way, it can be
honestly said that doctors have done their part in attempting to limit the
cost of health care.


If so, you'd better do some research. Dr. fees are only a
small part of the equation. Hospital costs are a far larger percentage,
and
profits to health care insurers is an equally-large percentage.

And I never indicated they were not.

And the
cost of absorbing the expense of hosptial and medical care for the
uninsured, impoverished masses may just be the largest percentage.

Come on Max. Since that slug Dickey Scruggs is suing most of the
hospitals in the country in a class action to make himself another
billion or so dollars, what they spend on the indigent is public
knowledge. Not anywhere near the largest percentage.

Notice I said "may just be". I really don't have the numbers, but I know
they are significant, especially at municipal hospitals such as the one
employing my wife. Such facilities cannot reject indigent patients.
Private facilities can and do.

In any
discussion of illegal immigration, this factor must be considered, because
it's significant. My wife had an undocumented Mexican patient on her
floor
at the hospital who required extensive care and treatment for a period of
6
weeks. After incurring an unpaid and unreimbursed (by the gov't.) bill in
excess of $1million, the hospital wanted to dismiss the patient to
long-term
care, but no one would take her. So the hospital covered the cost of
putting the woman on a private jet and flying her to Mexico City, where
she
was turned over to Mexican authorities for extended care. My guess is
that
they let her die.

But let gasoline go up and the cry begins. Mostly from people driving
urban assault vehicles and throwing their plastic (oil) disposable
junk out the window. And lining up at WalMart to get that cheap
chinese stuff, which is the primary reason for the world market in
energy going through the roof.

Yup. Do you advocate paying more for inferior, more costly domestic
goods?
Do you think you'll find anyone standing in line behind you in that
philosophy?

Hitting a sore spot here, Max, since I was one of those domestic
manufacturers making an "inferior" product that was "alledgedly" more
costly.

The product I used to make actually cost a little more now with a
strategy to high chinese content. The Corporate genius were shooting
for a 25% reduction in cost (with a strategy of no reduction in price
BTW). The basic cost is a push, some models higher some models lower,
The warranty element of the cost of quality is four times higher.
With warranty four times higher, relative quality comparison fairly
easy to make. Overall, everybody lost. The end user gets a crappy
product with no choice in the matter, other than the competitors
crappy product. The company is making less money,(so much less that
they sold off the division as a defensive move) and many good people
(with average seniority of 25 years) in this country lost their jobs.
And were talking about $25-35K highly productive people.

Market share for the product is down since it is now "just another
chinese import" garnering no end user loyalty.

And you might ask, why not just reverse it. Once you dismatle U. S.
manufacturing and destroy tooling, the cost of reentry is prohibitive.
If you try to go back you would have "more costly domestic goods"

Don't get me started on this one. Oh, you already have

Sorry to hear about your situation, Frank. My implication was not that US
goods should have been replaced with less costly foreign ones, but that is
what has happened, and it's impossible to reverse the situation now. What
has been lost is gone and, short of a major global catastrophe, won't be
returning ever. But my point is valid--e.g.--the Toyota Camry is the number
one selling model in the country now. There must be a reason for that.

Max

On Sat, 06 May 2006 03:22:03 GMT, "Maxprop"
wrote:

all that stuff above snipped as opinionated, for the most part
unsubstantiated, and mostly irrelevant drivel coming from both
participants



Sorry to hear about your situation, Frank. My implication was not that US
goods should have been replaced with less costly foreign ones, but that is
what has happened, and it's impossible to reverse the situation now. What
has been lost is gone and, short of a major global catastrophe, won't be
returning ever. But my point is valid--e.g.--the Toyota Camry is the number
one selling model in the country now. There must be a reason for that.

Max



My situation is fine Max, because of age and position, however many of
those who worked for me are struggling through no fault of their own.
I am very concerned because what happened to me and mine was
unimaginable given the performance of my operation. I was in shock
that it could even be contemplated much less initiated. I think it
has happened maybe hundreds or thousands of times in this country.

I am not a believer in the sustainability of the so called service or
transfer economy. I believe without a foundation of value added
endeavours were on a slippery slope.

Toyota represents a single industry. In my opinion two primary
factors put them where they are today. Gasoline prices, cheap in the
sixties and before then jumping up in the seventies causing a
political reaction by the government (mandated MPG averages) that
caused the U. S. auto industry to literally destroy themselves. And
U. S. industry in general running Demming out of the country causing
him to turn to those attentive ears in Japan.

Frank

Reported figures? Don't trust this sort of language. Especially if "they"
report them. :-)

--
"j" ganz @@
www.sailnow.com

"Dave" wrote in message
...
On Fri, 05 May 2006 04:46:02 GMT, "Maxprop" said:

And the
cost of absorbing the expense of hosptial and medical care for the
uninsured, impoverished masses may just be the largest percentage.

According to reported figures that cost represents between 2 and 3% of the
total. I think you've been reading too much AMA propaganda.

In article t,
Maxprop wrote:

"Peter Wiley" wrote in message
. ..

Good. I don't know how much congruence there is between Australian
medicine and the USA, but having doctors who are primarily interested
in curing the sick and preventing sickness strikes me as much better
selection criteria than people who are interested in money & prestige.
I don't have any problem with them having all of the above, just the
order of importance.

In order from most common to least, the reasons given by pre-med students
during selection process interviews with US medical schools is: 1) a
desire to practice medicine, 2) a desire to help people, 3) a need to be
involved in something significant and important, 4) the money, and 5) the
prestige. But when first year medical students were interviewed, the order
was somewhat different, with money and prestige leading the list. So, are
we to believe your Ozzy medical students are any different than our own?
Have you actually talked to any med students there, or are you just shooting
from the patriotic hip?

Hmm, I think I was unclear. I have no reason to believe that ours
differ in motive from yours and would be somewhat surprised if they
did. Just that I've never seen such a survey so can't say for sure.

Here, at least 1 med school screens candidates on a range of social
factors as well as straight exam performance. Can't see that the
results are noticeably worse.

They do precisely the same here. Often the straight-A students are passed
over in favor of those who perhaps had slightly worse GPAs (3.7 to 3.9 on a
4.0 scale) but were involved in extracurricular activities such as
charitable organizations, self-improvement projects, and athletics.
Well-rounded individuals, it seems, make better physicians than bookworms.
Imagine that.

Which would indicate that changing from a straight GPA (TER here) as a
basis for selection would cost nothing in terms of quality of doctor
and *may* pay off in other ways.

Thing is, *nobody* I know goes into R&D in most areas with the
expectation that they'll get filthy rich. They do it because they're
interested in a particular type/class of problem. In fact, obsessed
would be a better word than interested. If they do get rich, it's a
nice side effect.

So - if those truly motivated in the main by money & prestige choose
some other profession than medicine, good. I don't regard a doctor
practising family medicine as all that much superior to a good auto
mechanic, to tell the truth. Less than a vet surgeon tho a vet does
have the advantage of burying mistakes with less legal problems.

With the exception of cutting edge research, it doesn't really take
that many brains to be a doctor, and the really bright ones get super
bored anyway if they can't do new interesting things all the time.

The really bright ones generally find themselves in academia or pure and
applied research. You are correct in that it doesn't take an Einstein to
practice family medicine.

They get bored, in fact. Friend of mine has given up being a GP and is
doing a PhD in a health related area instead.

PDW

katy wrote:

Martin Baxter wrote:
katy wrote:
P.S. for Katy, presbyopia does not mean that I'm Presbyterian.
I knew that, Martin. So how much of your tax dollar per annum do
you contribute for health care?


Guess I should have included the smiley. ;-)

The average Canadian family pays about 48% of it's income in taxes,
(federal and provincial income, federal and provincial sales, booze,
gas..etc.), 40% of that goes to health care.

Cheers
Marty

OK, so according to 2001 stats, a median family income in Canada was
about 68k and you are paying around 13k out of your taxes for health
care that doesn't cover some things. If we were to COBRA (pay for
total policy on own) our BCBS plan, which covers many of the things
you've listed as exclusions, would cost us 9K per annum for a family
policy. We do have some small co-pays, which usually add up to
another 1.5k/annum ...

So we pay about about the same allowing for exchange, there are however
two important differences: Everbody gets equal coverage here including
the indigent. No one can get dumped by his carrier.

Cheers
Marty

Martin Baxter wrote:
katy wrote:
Martin Baxter wrote:
katy wrote:
P.S. for Katy, presbyopia does not mean that I'm Presbyterian.
I knew that, Martin. So how much of your tax dollar per annum do
you contribute for health care?

Guess I should have included the smiley. ;-)

The average Canadian family pays about 48% of it's income in taxes,
(federal and provincial income, federal and provincial sales, booze,
gas..etc.), 40% of that goes to health care.

Cheers
Marty
OK, so according to 2001 stats, a median family income in Canada was
about 68k and you are paying around 13k out of your taxes for health
care that doesn't cover some things. If we were to COBRA (pay for
total policy on own) our BCBS plan, which covers many of the things
you've listed as exclusions, would cost us 9K per annum for a family
policy. We do have some small co-pays, which usually add up to
another 1.5k/annum ...

So we pay about about the same allowing for exchange, there are however
two important differences: Everbody gets equal coverage here including
the indigent. No one can get dumped by his carrier.

Cheers
Marty
Does your medical coverage put age limits on some procedures like in
Great Britain? It is my understanding that in GB, if you are over
50, kidney transplant and I believe, dialysis, are not
available..also some heart treatments.